May 2, 2011

27 Percent Of Children Wait Too Long For Surgery

by ssavage

Please credit CMAJ, not the Canadian Medical Association. CMAJ is an independent medical journal; views expressed here do not necessarily reflect those of its owner, the CMA.

Twenty-seven percent of children in Canada awaiting surgery at pediatric hospitals received the procedures past the target date, found an article in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj101530.pdf.

Prolonged wait times are a pressing issue in health care systems and Canadian governments at the federal, provincial and territorial levels have made reducing wait times a priority. However, some procedures may need to be performed sooner than by the established six-month target date.

The study, by researchers from the Hospital for Sick Children (SickKids) and the Canadian Paediatric Surgical Wait Times Project, was based on 64 012 surgeries at Canada's pediatric academic health centres. Dentistry (45%), ophthalmology (43%) and plastic surgery (35%) had the highest percentage of delayed surgeries followed by cancer, neurosurgery, and cardiac surgery.

"Despite receipt of surgery within six months of the decision to treat for 90% of patients, clinically derived targets found that 27% of children waited too long for their specific condition," writes Dr. James G. Wright, The Hospital for Sick Children, Department of Surgery, with coauthors.

Delays in surgery can affect children's physical and cognitive development. For example, delaying surgery to correct strabismus risks a child's chances of having normal vision and can affect quality of life.

"We believe this national collaborative project shows the feasibility and potential benefits of setting nationals standards for surgical wait times. Such accountability can result in measurably improved access in the delivery of national publicly funded health care," they conclude.

In a related research article http://www.cmaj.ca/embargo/cmaj101511.pdf, researchers found that waiting for surgery beyond wait time targets can affect the outcomes and risks associated with surgery. The authors found that wait times longer than three months for adolescents with scoliosis increase the likelihood of complications and additional surgeries. Surgery to correct idiopathic scoliosis, an abnormal curvature of the spine that is potentially progressive during adolescence, is the most common reason for elective pediatric orthopedic surgery.

"The highest risks of adverse events due to prolonged wait times occurred in patients who were skeletally immature and had larger curvatures of the spine," writes author Dr. Henry Ahn, St. Michael's Hospital, Toronto, with coauthors.

They conclude that a three-month wait time, based on empirical analysis rather than on conventional methods such as expert opinion, helps minimize risk. "A maximal acceptable wait time that leads to a reduction in the progression of curvature also has the potential to reduce the strain on healthcare resources by decreasing the need for additional surgery."